Healthcare Resource Utilization and Medical Costs in Pulmonary Arterial Hypertension Management in Japan: A Retrospective Study Using a Claims Database

To investigate the healthcare resource utilization (HCRU), medical costs in pulmonary arterial hypertension (PAH) patients in Japan, implementation of right heart catheterization (RHC), and treatment intensity, a retrospective observational cohort study using a nationwide health insurance claims database provided by JMDC Inc. was conducted. Patients with PAH, classified based on evidence of a PAH diagnosis and PAH-targeted drug prescription within the same calendar month, were identified from the database. Demographic and clinical characteristics, as well as the implementation of RHC during the baseline period and the type of PAH-targeted drugs prescribed for the first-line therapy, were described. Outcomes included HCRU and direct medical costs between March 1, 2018 and March 31, 2023. A total of 405 patients with PAH were included in the analyses; 298 patients (73.6%) did not undergo RHC [RHC(−) cohort], and 107 patients (26.4%) underwent RHC [RHC(+) cohort] during the baseline period. Among the overall population, 59.3% received oral/inhaled monotherapy and 5.4% received parenteral prostacyclin analogue (PPA) combination therapy; 70.1% of the RHC(−) cohort received oral/inhaled monotherapy versus 29.0% in the RHC(+) cohort, 1.7% of the RHC(−) cohort received PPA combination therapy versus 15.9% in the RHC(+) cohort. Overall, the HCRU and the total medical costs tended to increase with treatment intensity in both RHC(−) and RHC(+) cohorts. The increase of the medical costs was mainly due to increase in costs related to hospitalization and prescription of PAH-targeted drugs. The results revealed that HCRU and medical costs were especially high in those who were treated intensively with PPA combination therapy at first-line. In terms of extensive HCRU and associated medical costs, the limitations of existing treatment strategies for PAH were noted. In addition, these results highlight the need for innovative treatments to reduce the considerable disease burden described in this study. Pulmonary arterial hypertension (PAH) is a rare disease in which the small blood vessels in the lungs become narrow so that blood cannot flow through the lungs as well as it should. The healthcare resource utilization (HCRU) and medical cost for PAH treatment in Japan have not been clear; thus, we investigated them using a nationwide health insurance claims database. We identified 405 patients who were diagnosed with PAH from the database. To diagnose PAH, implementation of right heart catheterization (RHC) is required; however, we found that the majority (298 patients, 73.6%) were diagnosed with PAH without undergoing RHC, as identified by using corresponding codes in the claim data. Overall, the HCRU and the total medical costs, as well as PAH-related HCRU and medical costs, tended to increase with treatment intensity (number of concomitant use of medicines for PAH treatment). We also found that the increase in medical costs was mainly due to the increase in costs related to hospitalization and the prescription of medicines for the treatment of PAH. This study suggests that the current treatment options for PAH might be limited in terms of HCRU and medical costs, suggesting that an unmet need remains for patients diagnosed with PAH to reduce HCRU and medical costs. The development of new treatment options would be warranted, especially to reduce the economic burden of PAH treatment.